Ideally, in the field of neuro-psychology, a trained, fully qualified expert should have the opportunity to spend a substantial amount of time with each client. This time should include a significant amount of observation and testing, on a one-on-one basis. Unfortunately, there exists a chronic shortage of such professionals and, therefore, the amount of time that can be spent with each client is very limited. In addition, there is a shortage of testing materials whereby a professional can monitor the testing of each client without being physically present but nonetheless in control of the testing.
There are, in existence and in use, many types of standardized neuro-psychological tests carried out through the medium of computers; but these have a significant drawback of being generally rather static. These are so described, not simply because the contents are monotonous, but, also, because the method of application is rather rigidly implemented. Each test needs to be substantially completed before proceeding to the next without any consideration of the nature of the answers or the reactions of the client.
Furthermore, when these tests are arranged into batteries of tests, the batteries become even more static, if not positively unwieldy. The reason for this is that setting up batteries of tests is done in a standardized manner and, only after the battery of tests are substantially completed by a client, does the neuro-psychologist review the results.
It should also be explained that a testing procedure carried out under the direct supervision of an experienced and expert professional neuro-psychologist is not carried out in the static manner described, but with continuous monitoring. If the professional tester reaches conclusions prior to the end of a test, the client will be redirected to further tests, rather than be allowed to proceed with a rigid regime of testing. It would, therefore, be of substantial advantage if there existed a methodology that could construct the necessary batteries of tests, in the same manner and using the same approach, that would be utilized by a group of well qualified and expert neuro-psychologists.
Furthermore, there are a number of factors inhibiting the growth and improvements of neuro-psychological testing, most particularly because the validation of tests is extremely costly, very slow and, perhaps most important of all, very time consuming. It would be most useful if new tests and new ways of testing could easily be validated.
The problems associated with validating neuro-psychological tests are that validation must explain a correlation to known instructions, must provide results with a usably narrow distribution and, hence, the ability to decide the result.
It is not always obvious that tests are a structured means of capturing a description of how an individual performs in a given set of controlled and observable circumstances. This statement underlines the basic problem. Neuro-psychological experts are not able to invest sufficient time with each client to be able to fully perceive the full and detailed nature of each problem. Ideally, there is an important need to understand, precisely, the nature of the client and his special needs.
Therefore, it would be of significant importance and advantage, if means existed to embody the metrics from validated tests together with the expertise of time-constrained experts and bring such formed and developed tests to bear in a field so desperately in need of advancement. It would be of even greater significance, if all this could be brought to bear utilizing normal routine activities of each client.
A specific objective of every neuro-psychologist is to help clients with their normal routine activities. Because such professionals do not have the time available to, the issue of a new and highly useful methodology of testing by monitoring normal routine activities on an ongoing basis, must come to the fore.
High level certification as a neuro-psychology professional, such as a neurologist, involves a long and complex course of study and apprenticeship. Ultimately this course of study is only successfully completed by a small number of individuals. Few patients are fortunate enough to receive the full benefits that may be provided by these certified professionals, essentially because there are to few such professionals available, and their time is over subscribed by the great numbers of patients needing their help.
Today, neuro-psychology professional services are restricted to four substantially small sub-populations, of the greater population of patients, who could benefit from proper care. These sub-populations are: persons needing screening, severely disabled persons such as accident or stroke patients, extremely wealthy persons who can purchase these scarce services at any price, and substantially random small groups who happen to be xe2x80x9cadoptedxe2x80x9d into some funded neuro-psychological research study.
Even within these groups, patients are not always able to receive optimal neurological care because of the time required for each test and its analysis, the time required to develop new tests, and the time required for the determination of the exact combination and sequence of tests to properly evaluate a given individual, which sequence may be different at each examination of the individual. Neuro-psychology professionals must spend a substantial amount of time administering tests that often yield little or no useful data. They cannot spend the vast amount of time which would enable them to observe patients in various circumstances, including routine normal activities, observation which would yield information enabling assessment of an individual""s condition at a given point in time, detecting the appearance of a new condition, and perceiving the changes in and progress of a known condition.
Neuro-psychology professionals are furthermore faced with limitations in developing new tests to diagnose specific conditions more accurately or quickly, again, often because of time and cost limitations. The neuro-psychology professional has limited means available to him to validate new tests, or even to correlate information gained from the performance of routine activities by an individual under normal conditions or those experiencing changes in such conditions.
In cases when a neuro-psychology professional does develop and validate a new test, he is faced with a further problem; that of collecting payment, or royalties, for the use of the test by others.
Given these pressing circumstances, there are clearly several distinct needs in the present art. There is a need for ways and means of successfully training more persons in the complex applied-knowledge practices of clinical neuro-psychology, leading to an increase in the number of properly certified neuro-psychology professionals. Independently, there is also a need for ways and means of successfully extending the benefits of care, under the auspices of certified neuro-psychology professionals, to respectively larger populations of patients, who substantially need their help, albeit perhaps to more varying degrees than members of the four select sub-populations that are described above.
Neuro-psychology professionals undergo a long, complex and arduous course of study and apprenticeship. All too few succeed. This results in a very limited number of clients, of a potentially very large number of clients, being able to benefit from these important professionals. Unfortunately, even this small number of clients only benefit to a relatively limited degree. One of the factors that exacerbates this limit, is the availability of up-to-date and normal routine activity tests. Another factor is the limited range of conditions that will yield to the relatively out-of-date testing methods available. For the neuro-psychological professional, the development and proper validation of normal activity tests, gives rise to the difficulty of financial recovery of the costs involved as well as a return on the investment of time and substantial effort.
There is, moreover, a need to extend the level of care that a neuro-psychgology professional is able to give specific groups of patients by increasing the efficiency of the testing and observation procedures, thus enabling the observation of a patient""s condition throughout the day or over an extended period of time, testing both by observation of a patient""s routine normal activities and by enabling multiple or duplicate testing throughout the day. Furthermore, there is a need for a method that will enable greater efficiency in the validation of new tests and correlation of data from new tests with known parameters. Finally, there is a need for a means to enable neuro-psychological professionals to collect royalties for tests, which they have developed and which are to be used by others.
There is a distinct need in the art to allow neuro-psychologist professionals to deal with a larger number of clients and to be able to make better use of the time available. In addition, this need will be substantially enhanced if better use can be made of existing standardized tests. Add to these aspects, the development of and the ability to validate new types of tests which can fulfill all these needs whilst providing a better professional-to-client relationship with the inevitable improvement in client evaluation and treatment.
Technical Issues: The present invention delivers, to individual or small groups of certified neuro-psychology professionals, an interface protocol for clinically monitoring and managing the neuro-psychological needs of very large numbers of individual patients. The preferred approach to such monitoring and testing, is within the scope of normal and routine activities. These patients are most often in need of regular testing, screening, and monitoring and, only occasionally, of referral or intervention.
Ergonomic Issues: The present invention provides a majority of patients, with regular testing, screening, and monitoring services on a xe2x80x9cvirtual-out-patientxe2x80x9d basis by interactively delivering individually configured batteries of tests to each patient, via the Internet. These tests will include normal activity observation and monitoring. The delivery and corresponding acceptance of the testing batteries is a substantially automatically scheduled feature of the protocol of the present invention. Normal anxiety, stress and lost time of the patient, all of which are accepted and associated with prior methods of providing such testing in a clinical office setting, are all simultaneously remedied by the present invention. The present invention provides a multiplicity of services to patients in their respective daily settings, such as at home, at work, or even in transit using ordinary cellular wireless interface data-communications infrastructures as well as provides a means of accumulating a data base of normal activity testing for subsequent validation. Furthermore, certified neuro-psychology professionals using the present invention are able to provide a higher standard of ordinary care to many or even all residents of institutional facilities, such as hospitals, rehabilitation centers, and other life-care service-providing support-structures. Because of the present invention, neuro-psychology experts will become able to amass the invaluable resource of a large scale database including a means of validating normal activity testing, and thereby be able to describe new statistically validated clinical longitudinal trends and other new life-saving clinical correlations.
Economic Issues: Two fundamental economic improvements are achievable using the protocol of the present invention. Because of the present invention, patients, who otherwise might have only benefited from the neuro-psychology experts"" consultation if circumstances had become life-quality critical, may now find that these services are available and affordable. Because of the present invention, neuro-psychology experts will be able to provide minimal care at low cost to a broad class of less than severely disabled persons, who have not, heretofore, had reasonable access to such services. Furthermore, because of the present invention, neuro-psychology experts will be able to modestly and efficiently conduct countless low cost neuro-psychological research studies, most especially related to normal routine activities, since such studies will become a virtual laboratory between the experts"" suspicions and the reality of the data base.
Numbers, alphabetic characters, and roman symbols are designated in the following sections for convenience of explanations only, and should by no means be regarded as imposing particular order on any method steps. Likewise, the present is herein described with a certain degree of particularity. However, those versed in the art will readily appreciate that various modifications and alterations may be carried out without departing from either the spirit or scope of the present invention, as hereinafter claimed.
In describing the present invention, explanations are presented in light of currently accepted scientific, technological or medical theories and models. Such theories and models are subject to changes, both adiabatic and radical. Often these changes occur because representations for fundamental component elements are innovated, because new transformations between these elements are conceived, or because new interpretations arise for these elements or for their transformations. Furthermore, the present invention will optimistically actually contribute to changing these theories and models. Therefore, it is important to note that the present invention relates to specific technological actualization in embodiments. Accordingly, theory or model dependent explanations herein, related to these embodiments, are presented for the purpose of teaching the current man of the art or the current team of the art, how these embodiments may be substantially realized in practice. Alternative or equivalent explanations for these embodiments may neither deny nor alter their realization.
Tests are computationally quantifiable instruments designed to assess one or more brain functions, including mental or motor functions.
A keyword that is used often in the occupational therapy world is xe2x80x9cactivities of daily living (ADLs)xe2x80x9d. ADLs are substantially concerned with the brain functions that contribute to a person""s abilities to do all daily activities, including highly skilled activities. These activities include xe2x80x98common tasksxe2x80x99 such as cutting food, writing, bathing, cooking, or xe2x80x98skilledxe2x80x99 vocational tasks such as performing surgery, watch making, or serving as a corporate executive. These are things that make up the person, in his interaction with the environment. Testing relates to accessing a metric related to any elemental brain function that contributes to these tasks. These metrics may not always be related to classical xe2x80x9cclinical neuro psychologyxe2x80x9d.
Client or patientxe2x80x94person being tested.
Clinician or neuro-psychology professionalxe2x80x94person prescribing or recommending the tests, such as a medical professional, a clerk in charge of vocational testing, a school social worker involved in investigating poor scholastic performance, a motor vehicles department clerk, etc.
Normal activities testing relates to testing and monitoring, whilst a client is carrying out tasks related generally to the use of communication devices and related equipment.
The present invention relates to a software driven protocol for managing a virtual clinical neuro-psychological testing program, the protocol including for each client of a plurality of clients the steps:
a) evaluating a prior history of the client;
b) according to the evaluated prior history, forming an appropriate battery of tests for testing the client wherein the battery incorporates pseudo-randomization of at least one representational or organizational parameter; and
c) via a data-communications medium, interactively
i. delivering, to the client, the formed battery of tests; and
ii. accepting, from the client, a substantially completed response to the delivered formed battery of tests;
d) analyzing the accepted response; and
e) into the prior history of the client, integrating
i. the accepted substantially completed response or
ii. at least one analytical metric thereof.
In general, this invention relates to software setting out a set of rules whereby a clinician will be able to manage a computer operated neuro-psychological series of tests for one or more clients. This process, with a large number of clients, is started with obtaining information from each client for the purpose of assessing testing requirements. On the basis of this information, a fairly standard series of tests are typically prepared for each client which include various non-specific tests or parts of tests, randomly inserted amongst the necessary tests. These tests are then conveyed to the client through the means of a medium such as the Internet or other communications inter-connection. After the client has substantially completed the tests, these are returned to the clinician as the tests progress, to be examined in the light of the information initially supplied by the client, with the objective of establishing a measure whereby the clinician is able to determine the client""s condition.
This procedure enables the neuro-psychologist to format tests and then, while monitoring each test and continuously having evaluated the results, by means of any one of a number of communication devices, to set further tests to more closely determine the client""s situation without having to expend time in personal attendance on the client. Randomly inserted and apparently irrelevant tests have two major purposes. Firstly, they represent a means of interrupting the monotony of a series of similar tests and secondly, these tests will provide a means for developing additional tests for assessment and validation so that the scope of testing is constantly being expanded.
Advantages to such a system and improvements to existing procedures is excitingly significant. Professional neuro-psychologists will be in a position to monitor many more clients, more frequently and more thoroughly, whilst simultaneously making a major advance in expanding the library of validated tests.
Furthermore, the present invention relates to a clinical protocol for normal-use activities, the protocol including the steps of:
a) for substantially each client in an ensemble of clients, monitoring at least one metric of normal-use activities;
b) for substantially each metric of the at least one metric of normal use activities, until a predetermined threshold of validation is achieved for an ensemble of clients, first, managing a virtual clinical neuro-psychological testing program for substantially each client in the ensemble; and correlating analytical metrics derived from the neuro-psychological testing program with the monitored metrics of normal-use activities, thereby validating at least one of the monitored metrics of normal-use activities as a neuro-psychological metric; and
c) for substantially each validated metric of the at least one metric of normal use activities, second, managing a virtual clinical neuro-psychological testing program for at least one client wherein a validated normal-use activity metric is used as a classical testing instrument.
In general the present invention also provides a means for developing testing procedures related to normal activities, generally with regard to each of a number of clients"" interactions with a computer or other communication device. Appropriate software enables the clinician to record and later compare measurements derived from these normal activities. This software provides the means for validating this normal activity testing. Such validated series of normal activity tests provide the means, then, to utilize these validated normal activity tests on a client.
The procedure described, enables a clinician to develop new validated forms of testing whilst conducting existing forms of tests without being physically present with the client. The usefulness of these newly validated tests, involving normal activities, cannot be over-emphasized in the light of the present lack of normal activity validated tests. Clearly the optimum and preferred method of testing would be direct observation, on a continuous basis, of normal activities by a client. Monitoring normal activities and evaluating the client on the basis of validated normal activity tests as outlined in the protocol described above could supercede lengthy direct, one-on-one observation.
It should be understood that this aspect of the present invention, though quite similar to the previous aspect, has some intrinsically significant differences. The utopian concept of professional neuro-psychologists being able to spend almost limitless time observing client normal activity behavior, comes a step closer with an increase in the available arsenal of testing materials. Also, tests can be formed and applied that are specific in terms of each client""s needs to a substantially larger number of clients and developed as normal activity tests rather than presently available rigid standard test batteries.
Notwithstanding the above, the present invention also relates to a software driven protocol for managing a virtual clinical neuro-psychological dynamic hierarchical testing program, the protocol including for each client of a plurality of clients the steps:
a) evaluating a prior history of the client;
b) according to the evaluated prior history,
i. interactively forming an appropriate battery of tests for testing the client wherein the battery incorporates pseudo-randomization of at least one representational or organizational parameter;
ii. via a data-communications medium, interactively delivering, to the client, the formed battery of tests;
iii. accepting, from the client, a substantially completed response to the delivered formed battery of tests;
iv. analyzing the accepted response; and
v. returning to step b)i until complete; and
c) into the prior history of the client, integrating
i. the accepted substantially completed response or
ii. at least one analytical metric thereof.
In general this procedure for testing differs from the initially described procedure. At present, the initial procedure utilizes a selection of a battery of tests transmitted to a client. After a substantially completed battery of tests is returned for evaluation, analyzed results are integrated into the historical information originally supplied by the client. This initially described procedure has a significant drawback, in that the whole structure of testing is inflexible and totally rigid in that completed tests are evaluated only subsequent to the client returning these. Generally, no provision is presently made for progressive monitoring of results, emanating from ongoing tests.
The procedure, described here, makes provision for avoiding this pitfall.
A battery of tests is selected by a neuro-psychologist as is the present practice. As the tests progress, from the continuous stream of results, the clinician is able to evaluate results as a continuum and can withdraw the running test, even mid-test. Substitute alternative tests are then introduced that will give a better insight into the client""s situation as well as the means for deriving a narrower distribution of results. This dynamic process of replacing ongoing tests, in a hierarchical way, may be repeated as often a necessary to achieve better and more specific results. Again, a specific stress is laid on the use of collecting and collating the results of the normal activity tests, concurrent with the above process. These normal activity results are then validated to provide normal activity testing facilities for use on clients.
Present conventions of neuro-psychological testing limit professionals to a small number of clients, who can only be monitored for a very limited amount of time, as opposed to the improvements that this dynamic hierarchical protocol envisages. More appropriate use can be made of a wider range of tests available from the usage of normal activity testing as well as the ability to monitor many more clients by means of communication devices. Most significant is the avoidance of the rigidity of existing testing methods insofar as tests envisaged in these aspects of the present invention, allow for a continuous interchange of results and tests between client and professional via the communication medium, enabling the professional dynamically to vary and to guide the tests hierarchically, to obtain results that will be more specific to the client""s situation.
An additional aspect of the present invention relates to a software driven protocol for managing a virtual clinical neuro-psychological testing program based on normal use activities, the protocol including for each client of a plurality of clients the steps:
a) evaluating a prior history of the client;
b) according to the evaluated prior history, forming at least one normal use activity factor of tests for testing the client wherein said at least one normal use activity factor incorporates pseudo-randomization of at least one representational or organizational parameter; and
c) via a data-communications medium, interactively
i. delivering the formed at least one normal use activity factor tests to the client;
ii. the client substantially completing the normal use activity factor tests; and
iii. accepting, from the client, a substantially completed response to the delivered normal use activity factor tests;
d) analyzing the accepted response; and
e) into the prior history of the client, integrating
i. the accepted substantially completed response or
ii. at least one analytical metric thereof.
In general, the invention also defines a procedure for carrying out testing procedures elaborated in the earlier parts of this description, but in this instance, the tests are built up, in a progressive manner, using the concept of previously validated normal activities testing.
Again, the neuro-psychologist specifies a software driven battery of tests. Again, the inclusion of apparently non-specific tests interspersed amongst the other tests is carried out to provide the client with a rest from the rigors of the ongoing testing as well as providing additional test information for later validation. Tests are conveyed to the clients through the means of a communications medium using a computer system or other personal communication device and, while being substantially completed, are returned to the clinician for recording, collating, contrasting and inclusion with the earlier recorded history of the client. It is stressed that this entire procedure relates to validation of and subsequent use of normal activities testing. This then is the optimal and preferred way of testing clients, without the continuous participation of the professional neuro-psychologist in attendance with each separate client and without the client being subjected to presently utilized lengthy, generally rigid and often monotonous tests.
In addition, the insertion of randomly placed and apparently inconsequential tests into each of the above test procedures, apart from breaking the monotony of testing, provides a means for developing new, innovative and perhaps novel, forms of neuro-psychological testing. Clearly, validation of these newly developed tests is a natural corollary to all of the above.
The ideal way for professional neuro-psychologists to carry out testing is to expend large amounts of time monitoring each individual client within the framework of normal and routine activities. This is not really possible when considering the lack of sufficient qualified professional experts. There are many aspects to the present invention that will emulate this idyllic scenario. Not only will the scope of each professional be expanded in terms of the number of clients who can be simultaneously monitored, but this monitoring will be in the context of normal activities testing. In addition, the scope of testing facilities will be expanded on an ongoing basis, as a consequence of the use of pseudo randomly incorporating normal activity tests.
The major thrust of this invention, is the development of a broad spectrum of innovative test methods, which will provide the professional neuro-psychologist with the means of dealing with substantial numbers of clients without the need to expend long hours of direct contact with clients. Professionals will also be giving a much higher quality of service to these clients. Most significant is the use of normal activities testing through the medium of commonly used communication devices.
To summarize, there is a specific problem that presently exists. Expert, professional neuro psychologists are unable to cope with the existing work load of clients requiring direct, continuous and long term monitoring in terms of their normal routine activities, especially using the generally rigid types of testing batteries available. The present invention provides a means of overcoming all these problems. Clients can be monitored directly on a continuous and interactive basis via communication media during performance of their normal routine activities, with the professional having the means to vary testing procedures as the pattern of client tests indicates a direction for achieving more direct and narrower results, specific to each client""s needs. Finally, the professional will be able to so monitor substantially larger numbers of clients, using these much improved and validated test methods. Validation of testing methods will naturally follow this new scenario, producing a much broader and improved scope for the professional neuro psychologist.